Sex and Medicine: Gender, Power and Authority in the Medical Profession

In 1849 Elizabeth Blackwell became the first woman to be placed on the British
medical register. By the 1990s women had come to account for over half of all
medical graduates and the proportion looks set to increase. In her new book
Rosemary Pringle considers the implications of this transformation for the practice of
medicine and, in turn, for conventional assumptions about gender, power, inequality,
and patriarchy. If, after a century of marginalisation and downright hostility women
are now having a major impact on medicine, Pringle suggests, we can no longer
conceptualise medicine as the lynchpin of patriarchy or indeed assume that western
cultures are patriarchal systems.

In exploring this premise, Pringle brings a skillful blend of historical analysis and
interview material divided into chapters which focus on the sub-disciplines of
surgery, gynaecology, the physician specialities, anaesthesia, psychiatry and general
practice. In each case, Pringle asks how far have women become integrated into the
field, at what levels, facing what difficulties and - critically - what impact are they
having on practice in their field? In addition, Pringle offers chapters on relations
between doctors and nurses and women doctors¹ involvement in the feminist health
movement. The interviews span an impressive range of women (150) and men (30)
aged from 24 to 92, working across the medical hierarchies in their chosen
specialisms. The interviews were carried out in both Britain and Australia, and Pringle
takes care to contextualise the specifics of each case, although in fact she finds
striking similarities between the two countries. (Nonetheless, whether this is
constitutive of a global medical culture, as she suggest, seems debatable).

Throughout the book, Pringle takes great care to avoid easy ascription of male
dominance or female powerlessness and this adds up to a forceful and convincing
gendered analysis which need take no recourse to reification or fixity. In this, Pringle
achieves a fine example of how the often rather abstract theoretical developments
within gender theory over the past decade can be integrated into new empirical
research. In particular, her research illustrates the fragmentary experience of gender
(with particular reference to the impact of class) and the dynamic nature of gendered
social relations. Drawing from Foucault¹s work on power allows Pringle the scope to
focus on agency, context and change, whilst use of Bourdieu¹s concept of habitus¹
allows rich description of priviledged medical identities, and analysis of the position of
different women and men in relation to these, without a hint of essentialism. Thus,
Foucault and Bourdieu effectively provide broad frameworks¹ for the book, as Pringle
identifies in Chapter One. Disappointingly however, the remainder of the book does
little to extend the use of these concepts, raising them only sporadically where
illustrative points are made about individual specialisms. In this sense, the distinctive
contribution which Bourdieu¹s work, in particular, might make to our understanding of
sex, gender and medicine seems to slip away leaving us with what we know
already: that cultural norms and expectations in medicine tend to fit more closely with
constructions of masculinity than those of femininity.

This said, Pringle has uncovered extensive evidence to show beyond doubt that
women entering the medical field are re-shaping those cultural norms and
expectations (or the contours of the field and the habitus it calls forth¹ (p.127)). The
overwhelming achievement of Pringle¹s book is the subtlety of her analysis and the
complex picture which she offers of the ways in which sex, gender, sexuality and
class are intertwined across a constantly shifting medical field. This indeed renders
untenable any simple analysis claiming that medicine equals patriarchy whilst
maintaining the centrality of gender to any understanding of medical discourse and
practice.